Pulsatile Tinnitus: Why You Can Hear Your Heartbeat in Your Ear

Pulsatile tinnitus is a whooshing, thumping or swishing sound that keeps exact time with your pulse. Unlike ordinary tinnitus, it is usually real sound produced by turbulent blood flow in vessels close to the ear, which means it often has an identifiable and treatable cause. Common contributors include raised blood pressure, anaemia, an overactive thyroid, a narrowed or looped vessel, and simple wax occlusion making normal blood flow audible. It always warrants medical assessment as well as a tinnitus assessment.

How to tell it apart from ordinary tinnitus

A simple test: take your pulse at the wrist while listening. If the sound and the beat line up, it is pulsatile. If the rhythm is independent of your heartbeat - for instance a rapid flutter or a steady tone - it is not.

The common causes

• • High blood pressure, which increases flow turbulence throughout the vascular system.
• • Anaemia or an overactive thyroid, both of which raise cardiac output.
• • Wax occlusion or middle ear fluid, which amplify normally inaudible internal sounds.
• • Atherosclerosis or a narrowed carotid artery, more likely with age and cardiovascular risk factors.
• • Venous causes such as a prominent jugular bulb or idiopathic intracranial hypertension, which classically worsens lying down.
• • Rarely, a vascular tumour such as a glomus tumour in the middle ear.

Why the fixable causes are worth checking first

Two of the most common contributors are cheap to exclude. A blood pressure reading and basic bloods cover the systemic side. An otoscopic examination covers the ear side, and if the canal is occluded, professional ear wax removal in Aylesbury can eliminate the amplification the same day. It is genuinely common for someone to arrive convinced they have a vascular problem and leave with clear canals and no whooshing.

Get urgent medical advice if tinnitus starts suddenly in one ear, pulses in time with your heartbeat, follows a head injury, or comes with sudden hearing loss, dizziness or facial weakness. Sudden one-sided hearing loss is treated as an emergency and needs same-day assessment.

Add to that list for pulsatile tinnitus specifically: new pulsatile sound with visual disturbance, headache that is worse lying down, or a sound your clinician can also hear through a stethoscope. Any of those should be escalated rather than monitored.

What assessment involves

1. GP review: blood pressure, pulse, bloods for anaemia and thyroid function, and auscultation over the neck and ear.
2. Audiological assessment: otoscopy, full audiogram and tympanometry to check middle ear function.
3. Imaging where indicated: MRI, MRA or CT angiography to look at the vessels around the temporal bone.
4. Ophthalmology review if raised intracranial pressure is suspected.

Audiology is not the whole answer here, but it is a necessary part of it. The audiogram establishes whether there is co-existing hearing loss, and tympanometry can pick up middle ear causes that imaging would miss.

Living with it while you are investigated

Pulsatile tinnitus is usually worst in bed, because lying down increases venous return and removes competing sound. Low-level sound enrichment helps in the same way it does for ordinary tinnitus - see our guide to sound therapy for tinnitus for how to set the level. Reducing salt and caffeine, treating blood pressure and improving sleep all help at the margins.

What does not help is waiting. Because so many causes of pulsatile tinnitus are identifiable, it is one of the few forms of tinnitus where prompt investigation genuinely changes the outcome.